Uso de métodos físicos para tratamento do diagnóstico de enfermagem de hipertermia em pacientes adultos internados em UTI: ensaio clínico controlado randomizado

Abstract

Since 1986, NANDA-International (NANDA-I) establishes the nursing diagnosis of hyperthermia. However, little is known about what is the best care that must be provided to adult patients with elevated body temperature. Usually, antipyretics are used in association with physical methods to decrease the temperature. Given these considerations, and facing limited knowledge about the best nursing care to adult patients with elevated body temperature admitted in Intensive Care Unit (ICU), it is debatable if the use of physical methods (ice packs and warm compresses), associated with antipyretic is more effective than the single administration of antipyretics, to reduce body temperature in adult patients with the nursing diagnosis hyperthermia at ICU. Objective: To evaluate the effect of application of physical methods (ice packs and warm compresses) associated with administration of antipyretic to reduce body temperature of patients in ICU, with the nursing diagnosis of hyperthermia. Method: Randomized clinical and controlled trial, conducted in 2 adult ICUs in a hospital of Belo Horizonte, MG, Brazil, from March 2012 to May 2013. Sample of 102 patients with body temperature 38.3°C of infectious cause. Patients were randomized into three groups: 34 patients received ice packs associated with antipyretic (Intervention I), 34 received warm compresses associated with antipyretic (Intervention II) and 34 received only antipyretic (Control). Tympanic temperature was measured at 15-minute intervals for 3 hours. Descriptive data analysis was used with simple frequency distributions, measures of central tendency and measures of variability. To evaluate the effect of interventions, the tests Mann-Whitney and Survival Analysis were performed. Effect size was also calculated. Results: The majority (64-62%) of patients were males aged between 22 and 82 years (M= 54; DP= 16). Average length of stay was 47 days and the most frequent type of hospitalization was of clinical patients (68-67%). Among the 102 patients in the sample, only 1 (1%) patient allocated to the Intervention group II did not show warm skin to touch; 42 patients (41%) presented tremors; and no patient had nausea, vomiting or seizures. There was variability in the mean tympanic temperature, with reduction over time in all groups. Patients allocated in Intervention group I had a greater reduction in the temperature from baseline to 180 minutes. Starting from 45 minutes of monitoring, these patients presented average tympanic temperature below 38.3 °C. No statistically significant evidence was found that patients submitted to the treatments of ice pack associated with antipyretic (p = 0.19) and warm compress associated with antipyretic (p = 0.41) have different probabilities of reducing tympanic temperature than patients receiving only antipyretic. It was found that the effect size for Intervention I was of medium magnitude, with the values of = 0.4 and for Intervention II was small magnitude, = 0.17 Conclusion: There was no significant difference between the interventions studied after 3 hours of monitoring. However, all patients in the group Intervention I presented reduced tympanic temperature compared to the baseline. For evaluation of effect size, group Intervention I presented an effect of medium magnitude.